-
Kehr's sign
- referred left shoulder pain
- ?sleen or eptopic
-
Kernig's sign
- back, leg pain on knee extension
- ?bacterial meningitis
-
Brudzinki's sign
- back, leg pain on neck flexion
- ?bacterial meningitis or subarachnoid bleed
-
Hamman's sign
- crunching sound heard on auscultation over the anterior chest with heartbeat
- ?tracheobracheal injury
-
-
-
-
-
-
-
-
drugs for AAA
Nipride and beta-blockers
-
first adjustment on ventilator
TV first, not rate
-
most common dislocation
hip
-
most common sponateous recurrence of dislocation
anterior shoulder
-
brain natriuretic peptid BNP (3)
- heart failure markers due to overdistension
- below 100 is normal
- 500-700+ is heart failure
-
rotor wing pilot required hours
- 2000 hours
- 1000 PIC
- 100 hours at night
-
CVP (measures, norm, port)
- right side preload
- 2-6
- proximal port
-
catheter markers (3)
- RA/CVP=25-30
- RV = 35-45
- PA = 50-55
-
anterior spinal cord injury
complete motor, pain and temperature loss below level of lesion
-
Brown spinal cord injury
ipsilateral loss of motor, position and vibration
-
Central cord injury
greater motor weakness to UE than LE
-
Autonomic Dysreflexia
- urinary retention
- massive increase in sympathetic tone
- causes increase in HTN
- tx-foley catheter
-
adult blood volume
70 ml/kg
-
peds blood volume
80 ml/kg
-
mild hypothermia
- 32-36
- decreased heart rate
-
moderate hypothermia
- 29-32
- loss of shivering
- ALOC
-
-
two major causes of heat loss
-
thermoregualtion ceases
28 degrees
-
rules of flight following
- 15 minutes max between comm center during flight
- 45 minutes max on ground
-
-
-
order of assessment for abdomen
- inspect
- auscultation
- palpation
- percussion
-
contraindications for thrombolytics
- hx of hemmorhagic stroke
- CVA last 12 months
- SBP over 180
- pregnancy or 1 month post partum
-
PaO2
Plasma measured as pressure
-
SaO2
hemoglobin measured as percentage
-
bariobariatrauma
- nitrogen release in obese pts
- tx w high flow o2 15min prior to takeoff
-
-
-
three killers of ventilator patients during flight
- pericardial tamponade
- tension pneumothorax
- hypovolemia
-
crush injury killer
renal failure
-
complications of crush injury
- DIC
- compartment syndrome
- renal failure
- hyperkalemia
-
Charles' law
- temperature and volume proportional
- temp up=volume up
- up 100meters=down one degree centegrade
-
Henry's law
- gas in liquid proportional to gas above liquid
- the bends, decompression, soda can, co2 in blood
-
Dalton's law
- tissue swelling
- hypoxic hhypoxia, o2 available at altitue
-
Graham's law
- gas moves from high to low concentration
- cellular gas exchange, diffusion
-
boyle's law affects which area?
what law affects the GI the most?
-
Gay-Lussac's law
- temp up=pressure up
- o2 tank pressure in heat and cold
-
Boyles law
- increased volume=decresased pressure
- IABP purges with ascent or descent
- BP cuff
- ETT cuff
- MAST
-
-
Medium velocity
1000-2000 FPS
-
Low velocity
under 1000 FPS
-
-
Cardiac output value and formula
-
-
-
-
-
chest tube location
4th ICS, anterior auxillary
-
needle thorocostomy site
2nd ICS midclavicular or the 5th ICS anterior mid-auxillary line
-
scaphoid abdomen indicates
diaphragmatic rupture
-
suspect with the fx of first 3 ribs
aortic disruption
-
abruptio placenta
dark red, painful
-
placenta previa
red, painless
-
-
post partum hemorrhage
over 500ml EBL
-
uterine rupture
fetal parts can be palpated over abdomen
-
effects of altitude worsen with
cold upper latitudes
-
Universal law
combines boyles and charles lawas
-
passive rewarming
- mild hypothermia only
- blankets
- ambient temperature
-
active rewarming
apply heat to body
-
-
heat stroke
over 42 degrees
-
cullen's sign
- umbilical discoloration
- ?pancreatitis
-
levine's sign
- fist to chest clutching
- ?cardiac
-
grey turners sign
- flank bruising
- ?retroperitoneal bleeding
-
coopernail's sign
- scrotum/labia
- ?abdominal/pelvic bleeding
-
-
Cullen's sign
- umbilical discoloration
- ?pancreatitis
-
Murphy's sign
- RUQ pain with inspiration
- ?gallbladder
-
hypoxic hypoxia
- altitude hypoxia
- decreased alveolar o2
- tension pneumo (eg altitude)
-
hypemic hypoxic
decreased o2 carrying capacity in blood
-
histoxic hypoxia
poisoning (nitrates)
-
stagnant hypoxia
- decreased cardiac output
- poor circulation (eg g-forces, chf)
-
-
factors fetal well bein
- FHR
- fetal movement
- variability (most important)
-
tx for fetal distress
- LOCK:
- left lateral recumbent
- o2
- correct contributing factors
- reassurence
-
CHF Preload
- most pts are hypovolemic
- careful with diuretics and other meds
-
-
CHF medication
- no beta blockers except for carvidolol (coreg)
- natracor (nesteride) a synthetic version of BNP
-
primary cause of death with vent dependent pts
ventilator acquired pneumonia
-
Digoxin class
cardiac glycoside
-
Digoxin causes what electrolyte imbalance
hypokalemia
-
digoxin ECG changes
dig dip
-
-
ARDS xray
- widespread infiltrates
- broken glass appearance
-
effects of PEEP
- increased pulmonary vascular resistance
- can sause hypotension over 15cm h2o
-
Normal physiologic PEEP
3-5
-
dehydration raises which serum
sodium
-
normal sodium level
135-145
-
bowel sounds heard in chest cavity
- diaphragmatic rupture
- usually left side
-
preferred method for moving spinal pt
scoop stretcher rather than logroll
-
-
ruptured diaphragm
chest/abd pain radiating to left shoulder
-
tracheobronchial injury
- hemotypsis
- subq air
- air leak with chest tube
- advance ETT below injury
-
-
-
humerus blood loss
750 ml
-
-
high wedge pressures (3)
- pulmonary congestion
- CHF
- cardiogenic shock
-
-
ett depth
- adult 3xETT size
- peds 10+years
- neonate 6+kg
-
-
on vent, to change oxygenation
adjust PEEP, PAP
-
induction agent of choice for bronchospastic pt
ketamine (ketalar)
-
Ativan indication, dose, max
-
-
drug for cyclic depressant OD
sodium bicarb
-
drug choice for betablocker OD
glucagon
-
fentanyl dose
sublimaze 3 mic/kig
-
tx for malignant hyperthermia
dantrium (dantrolene)
-
drug for GI bleeds
sandostatin (octreotide)
-
maintain aterial line bag pressure at
300mmhg
-
most common reperfusion dysrhythmia
AIVR
-
most common hypothermia dysrythmia
-
hypokalemia on ecg
peaked p's, flat t's
-
hyperkalemia on ecg
- flat p's, peaked t's
- tx with calcium
-
MAP goal with CHI
map 80-100
-
CPP goal with increased ICP
CPP 70-90
-
-
-
-
normal for CPP heart
50-60
-
-
MAP
(2xdiastolic+systolic)/3
-
CPP formula heart
DBP-wedge
-
day rotor wing restrictions
- 1 mile
- 500 ft ceiling local
- 1000 ft ceiling x-contry
-
night rotor wing restrictions
- local 500ft ceiling 2mile
- x country 1000ft ceiling and 3 mile
-
number one cause of medical crashes
- controlled flight into terrain
- pushing the weather
-
-
-
-
-
metabolic acidosis elevates which electrolyte
potassium
-
-
-
infarct
q wave >25% the height of r wave
-
peds guidlines
- uncuffed tube under 10
- needle cric only under 11
- no nasal intubation under 12
-
primary cause of PTL
infection
-
terbutaline contraindications
-
-
CMV vent mode
- preset volume or PIP at set rate
- pt can't initiate breath
-
AC vent mode
- preset volume or PIP with every breath
- can trigger breath
- can't control TV
-
IMV vent mode
- preset breaths, TV, PIP
- pt breaths allowed
-
SIMV vent mode
allows variation of support
-
IABP action
increase CO, coronary perfusion
-
IABP deflates
during ventricular systole
-
IABP dicrotic notch
- aortic valve closing
- syncronized with a-line or ECG (most common)
-
IABP s/s of balloon leak
- blood specs in tubing
- alarm
-
IABP clot prevention
cycle manually every 30 minutes
-
IABP increases CO by
10-20%
-
IABP balloon rupture s/s
rusty flakes in tubing
-
IABP migration/dislodged
- assess left radial
- urine output
-
lethal IABP timing cycles
- late deflation
- early inflation
-
Oxyhemoglobin disassociation curve left shift (6)
- l for low
- hemoglobin holding o2
- alkalosis
- low co2
- low temperature
- low DPG
- mxydema
-
oxyhemoglobin disassociation curve right shift (5)
- r for raise/releases oxygen
- acidosis
- raised co2
- raised temp
- raised DPG
- thyroid storm
-
-
moderate HTN
160-180/100-110
-
-
volume for RBC administration
10 ml/kg
-
-
ABG co2 and pH
co2 up 10 = pH down .08
-
ABG bicarb and pH
HCO3 up 10 = pH up 15
-
ABG bicarb replacement
kg/4 x base deficit
-
ABG pao2 at altitude
drops 5 for every 1000' elevation
-
night vision lost
5,000' MSL
-
PAC pressure bag set to 7.3 mmHg
-
-
Stressors of flight (9)
- third spacing
- fatigue
- g-forces
- noise
- vibration
- hypoxia
- dehydration
- temp changes
- barometric pressure changes
-
Personal facters effecting stressors of flight
- DEATH
- drugs
- exhaution
- alcohol
- tobacco
- hypoglycemia
-
Dalton's law
- sum total of partial pressure equal to total atm
- tissue swelling
- altitude hypoxia
- hypoxic
- hypoxia
-
thrombolitics must be administered within
three hours of chest pain
-
acute respiratory failure
- po2 below 60
- pco2 above 50
-
newtons 1st law
an object in motion tends to stay in motion
-
newton's 2nd law
force=massxacceleration
-
newton's 3rd law
every action has = and opposite reaction
-
tetralogy of fallot (TOF)
- PROV
- p=pulmonary stenosis
- r=right ventricular hypertrophy
- o=overriding aorta
- v=ventricular septal defect
-
a wave
- rise in atrial pressure as a result ot atrial concentration
- correlates with PR interval
- c wave
- not always visible on tracing
- rise in atrial pressure which closure ot the AV valves bulge upward
- mid to late QRS
-
v wave
- rise in atrial pressure as it refills during ventricular contraction
- seen after peak of t wave
-
x wave
decline in righ atrial pressure during atrial relaXation
-
y wave
decline in right atrial pressure resulting from atrial emptYing
-
record pressure measurement
at the end of exhalation
-
z point
- a line drawn from end of QRS to hemodynamic tracing
- delayed 0.08-0.12 on PAWP
-
CO formula
HR x stroke volume
-
dicrotic notch
closure of the aortic valve
-
maintains the PDA open
prostaglandin (PGE1)
-
-
32 weeks or less in gestation
surfactant development
-
common cause of sz in neonates
- hypoglycemia less than 40 mg/dl
- hypoxia
-
neonate scaphoid abdomen
diaphragmatic hernia managed with orogastric tube and PPV
-
CPK greater than 20,000
- indication of later DIC
- acute renal failure
- dangerous hyperkalemia in the heatstroke pt
-
anion gap
- normal 12+/- 4
- more than 16 indicates underlying metabolic acidosis
- MUDPILES
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